Thursday, January 14, 2016

Treatment creep in infertility

In the past, infertility treatment used to be fairly straightforward, because doctors didn't have much to offer to patients. They could perhaps educate them about when to have sex ( by tracking their " fertile time "; or tell them to have sex more frequently, but most doctors were forced to advice infertile couples to take a "wait and watch" attitude. With the introduction of clomiphene a few decades ago, we actually had a medical treatment we could offer to patients to help them to grow eggs, and this was a huge advance.

Over time, assisted reproductive technology ( ART) has improved considerably, which means there are now lots of treatment options we can offer to infertile patients, and this is why IVF is one of modern medicine's success stories.

The downside of this has been indication creep. This means IVF doctors have become increasingly aggressive about offering treatment options to their patients. Even young patients who could get pregnant with simpler treatment options are now being offered more complicated aggressive options, which are more expensive.

There are multiple reasons for this. It's not that doctors are greedy and they want to make more money. Patients also are under considerable time pressure, and they want quick results. They don't want to wait and go through all the simpler treatment steps systematically before getting a baby. They're quite happy to go to IVF directly if this gives them the baby which they want, without their having to waste time.

Another reason for this time pressure is societal. Women are getting married at an older age, which means their biological clock is running out and time is at a premium for them.

While the more advanced treatments have better success rates, they are also more expensive. While aggressive overtreatment can be helpful for patients who are mature enough to make their own decisions, it can also be misused, and lots of doctors will over treat patients only in order to maximize their income.

Doctors and patients need to find the right balance. Just because a doctor can do IVF doesn't mean that he should be doing it for all the patients who come to him. Patients should be encouraged to make these decisions for themselves after their options have been explained to them.